Cervical Region Flashcards
1
Q
What are the bones of the neck?
A
- Cervical vertebrae C1-C7
- Manubrium of sternum
- clavicles
- hyoid bone
2
Q
Defining features of hyoid bone?
A
- MObile
- Level of C3
- Greater and lesser cornu/horns
- landmark for administering sup laryngeal block for awake fiberoptic
- serves as attachment for anterior prop to keep airway patent
3
Q
What is the superficial cervical fascia?
A
- Subcutaneous tissue of neck between dermis and deep cervical fascia layer
- cutaneous nerves, blood, lymph vessels, fat
- Platysma
- thin, superficial muscle of facial expression
- CV VII
4
Q
What is the deep cervical fascia?
A
- Three fascial layers
- investing
- pretracheal
- prevertebral
- Allows structure to smoothly slide past each other
- i.e. swallowing, turning head
- allows for separation of structures during surgery
- supports viscera, muscles, vessels, deep lymph nodes
5
Q
What si the investing layer?
A
- Surrounds entire neck deep to skin and subcutaneous tissue
- encloses sternocleidomastoid muscles and trapezius muscles
6
Q
What is the pretracheal fascial alyer?
A
- Muscular part
- infrahyoid muscles (encloses muscle)
- visceral part
- encloses thyroid gland/parathyroid, trachea, esophagus
- Carotid sheath
- common and internal carotid arteries
- IJ vein
- vagus nerve
- carotid sinus nerve (from glossopharyngeal nerve- nerve of Herring)
- sympathetic fibers(carotid periarterial plexuses but NO cervical ganglion/trunk)
- role in infections and extravasated blood
7
Q
What is the prevertebral layer?
A
- Tubular sheath for the vertebral column and the muscles associated with it
- longus colli, longus capitis
- scalenes
- deep cervical muscles
- Retropharyngeal space
- potential space b/w visceral part of prevertebral layer to buccopharyngeal fascia
- permits mvmt of pharynx, esophagus, larynx, trachea relative to vertebral column during swallowing
- major pathway for spread of infection
8
Q
What is innervation/action of sternoclediomastoid?
A
- Action: unilateral: lateral flexes neck turning face superiorly toward opposite side
- bilateral extends neck at atlantooccipital joints
- flexes cervical vertebrae so chin approaches manubrium or
- extends superior cervical vertebrae while flexing inferior vertebrae so chin is thrust foward with head keep level
- assists with deep respiration
- Innervation- spinal accessory nerve (CN XI) for motor
- c2/c3 for pain/proprioception
9
Q
What is action/innervation of mylohyoid?
A
- Action: elevates hyoid, floor of mouth, and tongue with swallowing and speaking
- Innervation: nerve to mylohyoid, branch of CNV3
10
Q
What is A/I geniohyoid?
A
- Action: pulls hyoid anterosuperior; shortens floor of mouth; widens pharynx
Innervation: C1 via hypoglossal nerve (CN XII)
11
Q
What is A/I stylohyoid?
A
- Action: elevates and retract hyoid; thus elongating floor of mouth
- Innervation: stylohyoid branch of facial nerve (VII)
12
Q
What is a/i of digastric?
A
- Action: working with infrahyoid muscles, depresses mandible, elevates and steadies hyoid with swallowing and speaking
- Innervation
- anterior belly: nerve to mylohyoid, branch of CN V3
- Posterior belle: digastric branch of facial nerve )CN VII)
13
Q
What muscles make suprahyoid muscles?
A
Mylohyoid
Geniohyoid
Stylohyoid
Digastric
14
Q
What are the infrahyoid muscles?
A
Sternohyoid
Omohyoid
sternothyroid
Thyrohyoid
15
Q
A/I of sternohyoid?
A
- Action: depresses hyoid after elevation durign swallowing
- Innervation: C1-C3 ansa cervicalis
16
Q
A/I Omohyoid?
A
- Action: depresses retracts and steadies hyoid
- Innervation: C1-C3 ansa cervicalis
17
Q
A/I Sternothyroid?
A
- Action: depresses hyoid and larynx
- Innervation: C2 and C3 ansa cervicalis
18
Q
A/I Thyrohyoid?
A
- Action: depresses hyoid and elevated larynx
- Innervation: C1 via hypoglossal nerve
19
Q
A/I Anterior scalene?
A
Action: flexes neck laterally; elevates 1st rib during forced inspiration
Innervation: cervical spinal nerves C4-C6
20
Q
What is /AI of middle scalene?
A
ACTION: flexes neck laterally; elevated 1st rib during forced inspiration
INNERVATION: Anterior rami of cerivcal spinal nerves
21
Q
Pathway of CNXI?
A
- Deep to SCM as it supplies the muscle
- Deep to investing layer of deep cervical fascia
- deep to trapezius and pierces muscle
22
Q
Branches of cervical plexus?
A
- Anterior rami C1-C4
- Cutaneous branches emerge posterior border of SCM
- Transverse cervicla nerve (C2,C3)
- Great auricular nerve (C2,C3)
- Supraclavicular nerves (all sensory)
23
Q
What is the nerve point of the neck?
A
- A cervical plexus block
- done for CEA’s
- preffered anesthestic technique is awake, that way if they lose consciousness when carotid clamped, then you know they need a bypass
- Provide anesthesia to anterolateral neck, superolateral thoracic wall, and scalp b/w auricle and external occipital protuberance
- may temporarily paralyze the trapezius and +/- SCM
24
Q
What forms the cerivcal plexus?
A
- Series of nerve loops form anterior rami of C1-C4
- Anteromedial to elvator scapulae and middle scalene muscle; deep to SCM
- Superficial branches are cutaneous
- lesser occipital, transcervical, supraclavicular
- deep branches motor
- receives communicating branches from superior cervical ganglion (sympathetic nerves)
- forms ansa cerivcalis
25
What forms the ansa cervicalis?
* Superior root
* C1 and hypoglossal nerve
* superior belly of omohyoid
* Inferior root
* C2 and C3
* Sternothyroid
* Sternohyoid
* Inferior belly of omohyoid
26
What are the additional branches of cervical plexus?
* Lesser occipital nerve (C2)- Skin of neck and scalp to posterosuperior to auricle
* Great auricular nerve- C2&C3- Skin of posterior aspect of auricle, angle of mandible, and mastoid process
* Transverse cervical (C2&C3)- Skin of anterior cervical region
* Supraclavicular nerve (C3&C4)- Skin of neck, clavicle and shoulder
* Phrenic nerve (C3-C5; Mainly C4)
27
What is the phrenic nerve?
* FOrms on atnerior scalene muscle at the level of the superior border of the thyroid cartilage
* Passes anterior to anterior scalene, in front of SCL argery, behind SCL vein, under clavicle, on top of pericardium and inot diaphragm
* Motor and sensation to diaphragm
* sensation to mediastinum pleura and pericardium
* receives sympathetic communicating fibers from cervical sympathetic ganglia
28
Role of hypoglossal nerve and cerivcal plexus?
* Somatic motor to extrinsic muscles- styloglossus, hyoglossus, genioglossus (Except palatoglossus)
* also intrinsic muscle of tongue via lingual branches
* Provides superior root to ansa cervicalis to supply infrahyoid muscles
* exits via hypoglossal canal
* pathway deep to mylohyoid muscle
29
Glossopharyngeal pathway/innervation throughout cervical region?
* Exits via jugular foramen
* **Somatic motor** to stylopharngeus muscle to assist with swallowing, responsible for gag reflex (sensory)
* **Visceral motor-** PSNS innervation to parotid gland via otic ganglion
* **Special sensory-** taste post 1/3 of tongue
* cell bodies in superior and inferior ganglia
* **Gen somtic sensory to-** external ear, pharynx, middle eat
* cell bodies in sup and inf ganglia
* **Visceral sensor**y to carotid body and sinues
* cellbodies in sup and inf ganglia
Passes deep in neck to hyoglossus muscle
30
What is role of vagus nerve? Location in cervical region?
* Exits via jugular foramen
* **Somatic motor-** constrictor muscles of pharynx, intrinsic muscles of larynx, muscle of palate (except tensor veli palatini) and striated muscles of sup 2/3 esophagus
* **Viscerla motor**- PSNS to smooth muscle trachea, bronchi, digestive tract and cardiac muscle of heart
* **Visceral sensory-** base of tongue, pharynx, larynx, tachea, bronchi, heart, esophagus, stomach, intestine
* **Special sensory-** tast from epiglottis and palate
* **Gen somatic sensation-**auricle, external acoustic meatus, and dura mater of posterior cranial fossa
Passes through posterior aspect of carotid sheath- behind internal carotid and jugular vein
31
The left and right vagus nerves give rise to ____ \_\_\_ nerves
superior larngeal nerves
* have internal and external laryngeal divisions; level of greater cornu
32
Right vagus nerve passes ____ to first part of SCL artery, _____ to the brachiocephaliv vein and SC joint
anterior; posterior
33
What comes off right vagus nerve\>
Right recurrent larngeal nerve
* Loops inferior to right SCL artery and ascends
34
Left vagus nerve descends between the \_\_- ___ \_\_\_ and the ___ \_\_\_ ___ and posterior to SC joint
left common carotid; left subclavian arteries
35
What comes off left vagus nerve?
gives off left recurrent larngeal nerve
* Loops inferior to the arch of the aorta and ascends
36
What does the external laryngeal nerve innervate?
Cricothyroid
37
Why would a patient with aortic aneurysm have a hoarse voice?
Stretching of left recurrent larngeal nerve by aneurysm causing hoarseness of voice.
38
There are no ____ rami communicantes in neck
white
39
Pathway sympathetic nervous system in neck?
* Presynaptic fibers conveyed to sympathetic trunk by superior thoracic spinal nerves and white rami communicates
* SYnapse in cervical ganglia
* postsynaptic ganglia send fibers to
* cervical spinal nerves via gray rami communicates
* thoracic viscera via cardiopulmonary splanchnic nerves
* head and viscera of neck via cephalic arterial branhces (vertebral and internal, external carotid arteries) as the sympathetic periarterial plexuses
40
What is the inferior cervical ganglia?
* Stellate ganglion
* site for cervicothoracic ganglion block
* anesthesia for vascular spasms of brain and upper limb
41
What is horner syndrome?
* Pupillary constriction
* ptosis (drooping of eyelid)
* enopthalmos (sinking in of the eyeball)
* anhidrosis (loss of sweating) and vasodilation of face and neck
**This occurs because of parasympathetic nervous system taking over d/t blocking of sympathetic response c interscalene block.**
42
What is first branch off of the aorta?
* Brachiocephalic trunk
* first banch of aorta
* divides into right common carotid and right subclavian
* supplies right side cervical arteries
43
What arteries come off of right subclavian?
* Anterior scalene divides into three parts
* 1st: medial to anterior scalene
* vertebral artery, internal thoracic artery, thyrocerical trunk
* 2nd: posterior to anterior scalene
* costocervical trunk (ribs)
* 3rd: lateral to anterior scalene
* dorsal scalpular artery
44
What forms roots of cervical arteries on left side?
* Left common carotid artery
* second branhc of aorta
* Left subclavian artery
* third branch of aorta
* anterior scalene divides into 3 parts
* 1- medial to anterior scalene
* vertebral artery
* internal thoracic artery
* thyrocervical trunk
* 2- posterior to anterior scalene
* costocervical trunk
* 3- lateral to ant scalene
* dorsal scapular artery
more or less same as right side
45
What are the major arteries of the cervical region?
* Vertebral arteries
* common carotid arteries
46
What are the vertebral arteries?
* Foramina of the transverse rpocesses of the vertebrae (C1-C6)
* Enters cranium through foramen magnum
47
What are the divisions of the common carotid?
* **Internal carotid arteries**
* no cervical branches--\> *goes straight up to head to provide circulation to circle of willis*
* enter cranium through carotid canals
* main arteries of brain and structures in the orbits
* **External carotid arteries**
* supply most structures external to cranium
* terminal branches
* maxillary
* superficial temporal arteries
* superior thyroid artery
48
What is the carotid body?
* Medial (deep) side of the bifurcation of common carotid
* carotid branhc (sinus nerve of hering) of glossopharngeal nerve (IX), vagus (X), and superior cervical ganglion
* chemoreceptor monitors level of **oxygen** in blood (po2)
* low levels of oxygen stimulate a reflex that increases rate/deep of respiration, cardiac rate and BP
49
What is the carotid sinus?
* Bifurcation of common carotid- slight dilation
* carotid branch (sinus nerve of hering) of glossopharngeal nerve (IX), Vagus nerve (x), and superior cervical gnaglion
* **baroreceptor**
* stimulated by increase in arterial BP results in **decrease of HR** and **SVR**
50
Pathway of external jgular vein?
* Begins near angle of mandible
* terminates in SCL vein
* receives blood from cervicodorsal, suprascapular and anterior jugular veins
* some facial, mostly head/neck drainage
51
Pathway IJ vein?
* Receives drainage from brain, anterior face, cervical viscera, deep muscles of neck
* jugular foramen to subclavian vein **within** carotid sheath
* lateral to carotid artery and CN X
52
Pathway of subclavian vein?
* Anterior to anterior scalene and phrenic nerve
* Joins IJV and EJV to form brachiocephalic vein--\> SVC
53
Where is thyroid gland located?
* Deep to sternothyroid and sternohyoid
* Level of C5-T1
* left and right lobes
* two main arteries
* Superior artery (branch of external carotied)
* inferior artery (branch of thyrocervical trunk) artiers
* *need smooth, easy wakeup for patient. may rupture arteries with bucking wake up, causing compression of trachea*
* Nerves are derived from cervical sympathetic ganglia
* vasomotor
* endocrine secretion regulated by pituitary gland
54
Where is parathyroid gland?
* Lie external to thyroid capsule on **posterior aspect**
* typically four parathyroid glands
* nerves are derived from cervical sympathetic ganglia
* vasomotor
* endocrine secretion regulated by pituitary gland
55
What does esophagus muscle consist of? What innervates it?
* VOluntary, striated, muscle in upper 1/3
* involuntary, smooth muscle in lower 1/3
* mix of both in middle 1/3
* Inferior pharyngeal constrictor muscle creates superior esophageal sphincter
* Nerve supply
* superior half: sensory and somatic motor via recurrent larngeal nerve of vagus
* inferior: PSNS innervation and sensory by vagus nerve, vasomotor fibers by cerivcla sympathetic tunks
56
A/I of occipitofrontalis
* Action: elevates eybrows, wrinkles skin of forehead
* innervation: facial nerve
57
A/I orbicularis oculi?
Action: closes eyelids; orbital sphincter
Innervation: facial nerve
58
A/I orbicularis oris?
Action: closes mouth, compresses and brotrudes lips
Innervation: facial nerve
59
A/I buccinator
Action: presses cheek against molar teeth; works with tongue to keep food b/w occlusal surfaces; cheek muscle
Innervation: facial
60
A/I platysma muscle?
Action: depresses mandible, tenses skin of inferior face and neck
innervation: facial nerve
61
What are the six motor nerve branhces of facial nerve?
* Posterior auricular branch
* temporal branch (nerve stimulator)
* zygomatic
* buccal
* mandibular
* cervical
Bell's palsy results in unilateral paralysis of some or all of the muscles on affected side
62
What are cutaneous innervation to face and scalp?
* Anterior to auricle is by 3 division of trigeminal nerve
* V1- opthalmic
* V2- maxillary
* V3- mandibular
* *trigeminal neuroalgia- excruciating facial pain, thought ot be cuase by vessel that compresses sensory root of V*
* Posterior to auricle is by spinal cutaneous nerves
* Greater and third occipital nerves (posterior rami C2, c3)
* Great auricular nerve and lesser occipital (anterior rami C2, C3)
63
What provides superficial vasculature to face and scaplp?
* Great variability and anastomosis
* most superficial artieries of face arise from external carotid artery
* except supratrochlear and supraorbital arteries which arise from itnernal carotid artery
* **Majority of facial veins drain into the IJ vein**
* **auricular and post-auricular regional veins drain into external jugular vein (posterior)**
64
Majority of facial veins drain into ____ \_\_\_\_
**IJ vein**
65
Auricular and post-auricular regional veins drain into the \_\_\_
external jugular vein (posterior)
66
How is parotid gland innervated?
CNIX via otic gland
However, facial nerve, external arotid artery and retromandibular vein go right through parotid
67
What are the muscles of mastication? All innervated by?
* Temporalis
* Masseter
* Lateral pterygoid
* Medial pterygoid
All innervated by V3 provide muscles of mastication
68
What is contained in infratemporal fossa?
* Maxillary artery- branch of external carotid artery
* V3
* general somatic sensory from skin over mandible, lower lip, side of head, mandibular teeth, TMJ, mucosa of mouth and ant 2/3 tongue
* somatic motor to muscle of mastication
* Chorda tympani nerve
* facial nerve (VII)
* Joins with lingual nerve of CN V3
* Taste ant 2/3
* presynaptic PSNS fibers for submandibular/sl glands via submandibular gnaglion
69
Role of V3?
V3
* general somatic sensory from skin over mandible, lower lip, side of head, mandibular teeth, TMJ, mucosa of mouth and ant 2/3 tongue
* somatic motor to muscle of mastication
70
Role of chorda tympani nerve?
Chorda tympani nerve
* facial nerve (VII)
* Joins with lingual nerve of CN V3
* Taste ant 2/3 tongue
* presynaptic PSNS fibers for submandibular/slublingual glands via submandibular ganglion
71
Which are of facial vasculature is not provided by external carotid artery?
supratrochlear and supraorbital arteries which arise from internal carotid artery
